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Chapter 2 THE ATHLETIC HEALTH CARE TEAM Effective delivery of health care to sports participants is best achieved through a team approach. A Team includes a BOC Certified Athletic Trainer, a medical physician director, and EMS personnel who then work in concert with additional personnel such as school nurses, medical specialists, dentists, counselors, and others. This group comprises the athletic health care team (AHCT) and it coordinates on-site with coaches, administrators, athletes and parents to plan all aspects of a comprehensive medical care plan for a particular setting, typically a secondary school setting. The critical functions of the AHCT were recently outlined in detail in a publication in the Journal of Athletic Training and were based on the findings of a task force that identified and defined the components necessary to effectively provide medical care in the secondary school setting. The athletic trainer can be on-campus daily and make decisions regarding injury severity, medical referral, and return to play. This individual can serve as the “point person” in coordinating the day to day operation and directives of the athletic health care team. When an athletic trainer is unavailable, coaches who are trained in first aid and CPR should offer basic first aid and lifesupport services. The physician, athletic trainer, and coaching staff should coordinate efforts regarding injury prevention. The team should also be involved in pre-participation health screening; development and implementation of an emergency plan; medical supervision; injury recognition, treatment, and rehabilitation; record keeping; and education programs. I. Sports Medicine. A. Sports medicine is defined as “a field that uses a holistic, comprehensive, and 1 multidisciplinary approach to health care for those engaged in sporting or recreational activity.” 1. Sports medicine practitioners include primary care physicians, orthopedic surgeons, athletic trainers, sports physical therapists, dentists, exercise physiologists, conditioning coaches, and sports nutritionists. B. Sports medicine services for professional athletes typically include conducting preseason physical exams; proper skill instruction; conditioning programs; nutrition education and dietary counseling; preventive taping, strapping, and bracing; and acute injury care, referral, and rehabilitation. 1. Interscholastic athletes typically have fewer services available, but usually include preseason physical evaluation/examination. A growing number of schools employ a BOC-certified athletic trainer. The NATA publishes Appropriate Medical Care for Secondary School– Aged Athletes that outlines essential components and members of the team. C. In the past, an orthopedic surgeon provided health care for professional and college athletes. Current trends indicate that more “primary care” physicians will become providers of sports care medicine. Physicians can receive specialized training by entering sports medicine fellowships that last 1 to 2 years and can lead to the credential, Certificate of Added Qualifications in Sports Medicine (CAQ). II. Key Members of the Team. The coach, team physician, and BOC-certified athletic trainer are essential members of the team. A. Coaches in public school settings should receive training in basic conditioning procedures, maintenance and fitting of protective equipment, first aid and CPR, operation of 2 an automatic external defibrillator, recognition and management of common sports injuries, and skills instruction for athletes. This is especially critical in contact/collision sports that are inherently more dangerous and can be made even more so by athletes performing skills incorrectly. B. Team physicians are medical doctors who agree to provide at least limited medical care to a particular sports program or institution. The duties of the team physician are listed on page 26 under “Medical Management of the Athlete” and “Administrative and Logistic Duties.” Physicians may be willing to volunteer as team physicians. C. A BOC-certified athletic trainer is an allied health care professional who completes a bachelor’s or master’s degree with extensive academic and clinical training in care and prevention of sports injuries. 1. Athletic trainers provide services in the following areas: prevention; clinical evaluation and diagnosis; immediate care; treatment, rehabilitation and reconditioning; organization and administration; and professional development and responsibility. D. In the United States, the NATA is the professional membership organization for the profession of athletic training. BOC certification is granted upon qualifying for and successfully completing the certification examination that is now offered via a national network of computerized testing centers. 1. To qualify, one must complete an educational program that is accredited by the Commission on Accreditation of Athletic Training Education (CAATE). A list of core-subject matter areas in CAATE-accredited curriculums is shown on page 27. III. Requirements for Application for the BOC Certification Examination. When they apply to take 3 the certification exam, students must meet the criteria listed on page 27. To remain certified, an athletic trainer is required to earn continuing education credits and report these to BOC every 3 years. IV. Professional Settings for the Practice of Athletic Training. With the growth of the field of sports medicine in the 1980s, there was a parallel growth in a new type of medical clinic within the U.S., known as a sports medicine clinic, these practices were typically staffed with an orthopaedic surgeon and allied health personnel including athletic trainers and physical therapists. Their patient population consisted of high school, college and recreational athletes. Services included outpatient physical therapy, fitness evaluation and exercise prescription, lifestyle counseling, evaluation and treatment of injuries, and even sports medicine research. Growth in the number of these clinics was characterized as explosive through the 1980s and many athletic trainers found employment in this setting. A. In addition to clinics, many hospitals provide sports medicine health care as part of outpatient services. A few corporations also provide on-site health and fitness programs that offer professional opportunities for athletic trainers. Professional sports teams also provide jobs for athletic trainers. B. The Secondary School Setting. To reduce costs, schools can hire teachers who are also certified athletic trainers. A recent study found that the national average annual salary for high school athletic trainers was approximately $47,822. 1. A certified athletic trainer on staff can reduce the school’s legal vulnerability for claims relating to sports injuries. Additionally, the trainer can teach classes such as basic injury care, first aid and CPR, nutrition, and physical conditioning. 4 C. Locating a BOC Certified Athletic Trainer. NATA has a placement service for certified athletic trainers. Another option for locating qualified persons is to contact universities that offer CAATE-approved curriculums in athletic training for information about recent graduates from the programs. REVIEW QUESTIONS 1. Define the term sports medicine. 2. What is the CAQ and how does it relate to the team physician? 3. List the specific services that should be provided to the athlete by the team physician. 4. What are the six practice domains that comprise the role of the BOC-certified athletic trainer? 5. List several professional medical organizations that promote the study of sports medicine. 6. What has been the largest employment market for athletic trainers in recent years? 7. Briefly describe seven different employment options for a BOC-certified athletic trainer in the school setting. Elaborate on the advantages and disadvantages of each option. 8. True or False: It is generally acknowledged that sports medicine service in the future will be provided by medical specialists rather than primary care physicians. 5 9. List the 10 specific subject areas in the basic and applied sciences that are required by the CAATE for accredited curriculums in athletic training. 6